To ask the Chief Secretary to the Treasury to make a statement on the implications for patients of the taxation of NHS pensions.

The unforeseen consequences of recent pensions legislation, initially supported in all parts of the House, are now resulting in very worrying consequences for the NHS as hospital doctors who have regularly worked weekend overtime in order to get waiting lists down, are understandably refusing to continue to do so because they are being made worse off as a result. Can we imagine a conversation between couples along the lines of, “So you are leaving me and the children again this weekend to go voluntarily to work to make our family worse off?” It is not going to happen, is it? The same applies for GPs, many of whom are now doing fewer sessions each week than they want to and their patients desperately need in order not to be made worse off by breaching their annual pension allowance.

We do not have conscription for healthcare staff; we cannot force them to do weekend overtime or more sessions than they want to, and it is not surprising that they choose not to if they are being made worse off as a result. For example, in The Guardian this morning we learned of one senior anaesthetist who worked 27 Saturdays last year in order to reduce waiting lists and has now said he cannot afford to work any extra Saturday shifts this year because it would give him a large tax bill he cannot afford to pay.

Very few doctors have earnings that exceed the adjusted income threshold of £150,000 but due to the inclusion of hypothetical pension growth as income, doctors are being affected by tapering. This is different from what the Chancellor said in Treasury questions on 21 May when he said that someone has to be earning over £150,000 a year before the tapered annual allowance affects them. Taxable income and adjusted income are very different as regards pensions taxation.

The Government should also be aware that members of the imposed 2015 pension scheme had no option but to become a member of multiple schemes including the GP CARE—career average revalued earnings—scheme and as a result incur significantly higher annual allowance tax bills than those members who are protected members in only the final salary scheme. This means that all full-time consultants who are a member of more than one NHS pension scheme will be affected by the tapered annual allowance and will need to reconsider how much work they do for the NHS to mitigate these tax charges. Furthermore this punitive pensions tax penalty means that doctors are not just working less but are retiring earlier than they would like to in order to avoid significant additional tax charges. In a survey of more than 2,400 consultants, more than half cited pensions taxation as a reason for their decision to retire early.

I therefore have five questions for the Chief Secretary. As the 50-50 pensions accrual option proposed does not remove the unintended consequences that are forcing doctors to reduce the work they do, can this be included in the consultation so that this issue is raised? Once the scope of the consultation has been extended to cover this essential aspect can it then be launched as quickly as possible? Can the consultation be brief as the issues are well-known and well-rehearsed, and can the Government then respond quickly to it and if necessary legislate given that there is likely to be cross-party support for these important measures to protect the NHS? Can timely pensions statements be provided to all NHS staff who are affected by these measures? Finally, can the Government confirm that they understand the urgency and importance of this issue and that they will act without delay to prevent a deteriorating situation from getting even more acute?

I am grateful to the hon. Member for South West Bedfordshire (Andrew Selous) for asking this urgent question. It follows a Westminster Hall debate two weeks ago on this issue, when Members from across the House raised concerns about the Government’s mismanagement of the interaction between their pensions relief policies and the NHS pension schemes.

The worst-case scenario that we all feared has become a reality. Hospital leaders are raising the alarm that waiting lists for routine surgery have risen by up to 50%. Unless this issue is dealt with, there is a risk that the approach of the end of the financial year will lead to even greater levels of working to rule after the summer.

The changes that have led to these issues relate to the interaction of the taper, which George Osborne introduced in the summer Budget of 2015, with other rules on tax reliefs and the three NHS pension schemes. Despite decisions being taken around these measures some time ago, there appears to have been next to no communication by the Government with representative groups about this issue until the crisis had already begun. That is very different from the “constant review” that the Chief Secretary to the Treasury has just referred to.

It is fair that tax reliefs should be consistent with other core principles of taxation, and that the pension allowance should decline progressively for those people who earn high incomes. However, at issue here is the interaction of that system with the NHS pension schemes, on which the representative organisations maintain they were not properly consulted. Many consultants are only now becoming aware of their liabilities. I asked two weeks ago, and I ask again, whether the Government believe that their communication with those affected has been sufficient? Furthermore, does the Chief Secretary to the Treasury believe it is acceptable that many of those affected have not even received pension statements in a timely manner, due to delays by Capita? Surely that is only exacerbating these problems.

The Government have maintained—the Chief Secretary to the Treasury did this again a moment ago—that this issue will be solved by the 50:50 pension option proposed in the NHS people plan released last month. However, a number of representative bodies have already expressed concerns about this option. So my third and last question to the Chief Secretary to the Treasury is: what discussions has her Department had with the Department of Health and with those representative bodies about the 50:50 scheme? It has been painfully clear from the Westminster Hall debate, and again this afternoon, that there has been an abject lack of co-ordination across Departments on this issue.

I am sure that many of us are concerned about the lasting impact of today’s crisis. NHS staff retention is already poor. This issue is one of many affecting dedicated senior staff, with large numbers raising concerns about levels of stress and a general lack of resource. A whole variety of Government failures is driving these retention problems. Today’s crisis is likely to add to this, with confusion over pension relief pushing many to retire earlier than they previously would have done, or encouraging some to opt to take on additional private work. I am concerned not only for those consultants but for their patients. There are currently 100,000 NHS staff vacancies; that is one in 11 of all NHS posts. This latest failure will see yet more delays for people in desperate need of care, unless the whole of this Government, working together, get a grip.

Order.

In west Berkshire and Wokingham we desperately need to recruit and retain more doctors and other senior medical personnel. Will the Treasury look at the 60% tax rate that kicks in at £100,000 for a band of income above that? A lot of important public service workers, not just in the NHS, are caught in that band and are paying higher marginal tax rates than people earning a lot more.

Tapering lifetime allowances have already driven many senior doctors out of the NHS in their late 50s. The issue now is the tapering annual allowance, which is reduced by £1 for every extra £2 earned. This issue was raised in 2017; it has not just come to light. In May the Chancellor talked about a threshold of £150,000, yet the problem kicks in at £110,000, and many senior consultants and GPs earn above that. The average extra bill is £18,500, but many have faced tax bills of almost £100,000. The British Medical Association survey shows that three quarters are citing this as a reason to retire. At the moment all income, including non-pensionable income, is included. That does not make sense, so can that be changed? It is not just earnings, but the growth of a pension, yet people might not live long enough for that to be income, so why is it counted? The BMA does not think that the 50:50 approach will solve the issue, so will the Treasury have open consultation and, because this is about interaction with the pension system, look at all the options? Otherwise, we will face a workforce meltdown.

It is welcome to see a Treasury Minister answering this question; it was a Health Minister in the Westminster Hall debate. As a former cancer Minister, I was incredibly proud of our Government’s 75% ambition, and I doubt whether there is a Member in this House who does not support that. The news from my trust is that this pension issue is hitting radiology, which is hitting cancer diagnoses. Theatre lists are being cancelled because we cannot get anaesthetic cover, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) mentioned earlier, so may I stress to the Minister the urgency of the situation? We need to grip this and fast, because the longer this goes on and the further it falls, the harder it will be to retrieve. Urgency is the key word here.

This matters first and foremost because of the impact on patient care, not only through increased waiting times in hospitals but in patient’s ability to see a general practitioner out of hours. May I stress the urgency of the situation, as others have? Patients cannot afford to wait for the extended process of finding a new leader of the Conservative party.

May I briefly flag up another issue? One of my constituents, who wrote to me recently to say that he had requested an update on his pension, was told that it would take three months. He was then informed that Primary Care Support England had not updated his pension records for three years and that he would have to wait a further three months once they had been updated. Will the Minister also look at the delays facing doctors trying to get an update on their situation?

I thank my right hon. Friend for her statement. Will she confirm that this problem, as she said at the beginning, was created in 2016? Working hard for a few weeks now is probably necessary, but it ought to have been possible, by paying attention to the representatives of consultants and GPs and to those in these sorts of areas with similar earnings, to realise that this problem should not have been allowed to continue for quite so long. Will the Minister’s advisers look at the British Medical Association’s “Frequently asked questions”, which in February spelt out many of these issues? I ask, for the sake of those involved and the patients they wish to serve, that there should be a bit more speed—I almost gave it in Latin, but I might have sounded like a Tory leadership candidate. Get on with it, please.

My local hospital made it clear today that the 50:50 contribution proposal will not solve this problem because, as other Members have said, the problem is the taper. The problem is in the Treasury, not in the Department of Health and Social Care. How many more people have to wait longer for their operations before the Chief Secretary to the Treasury focuses on her day job and gets a solution to this problem?

We have created the most unbelievably complicated tax system. If working additional time makes the pension pot larger, there could be a 55% tax charge when taking those surplus benefits, and restrictions on the annual allowance are resulting in these large tax bills.

It is not surprising that many health professionals are choosing not to do the extra work or are simply retiring earlier. My right hon. Friend the Member for Wokingham (John Redwood) makes a key point, because extra earnings would take many of these people into the slice above £100,000 to £125,000, where a 62% tax charge applies.

This is not just an NHS problem. My concern is that we are putting a brake on those entrepreneurs who want to create enterprise, jobs and the tax payments of the future. A simple step would be to get rid of the lifetime allowance.

I am taken aback by the Minister’s complacency. We all know that patients are suffering because of this policy. What can be done to ensure that doctors who want to do the right thing by taking extra work and doing extra shifts are not left out of pocket?

May I add to the sense of urgency by speaking up on behalf of the chief executive of my local community hospital trust? This is affecting not only clinicians but senior staff, too. They want to continue in many cases, but now they are leaving. These are highly valuable, experienced people whom we need to run these trusts. Please can we sort this out as soon as we can?

The Chief Secretary keeps saying this is a matter for the NHS, and certainly the problems it has created for waiting lists and operation times are a problem for the NHS, but does she not accept that this problem has been created by the Treasury? The Treasury needs to look at how to resolve the problem, and it needs to consider what is creating these problems within the NHS, rather than passing the buck to the Health Secretary.

In addition to the important points made by my right hon. Friend the Member for Wokingham (John Redwood) and my hon. Friend the Member for South Thanet (Craig Mackinlay), would it not be simpler and fairer to restrict pension relief to the basic rate and scrap all annual and lifetime allowances?

Constituents have been raising this issue with me. Not only have clinicians been affected, but patients have been left waiting longer for treatment, which seems totally unnecessary, given that the problem is that clinicians who are willing and wanting to work are in a position where they would not be earning money for working. They are not prepared to sacrifice that family time to come in to do those extra hours that they have been doing for many, many years. This problem could be fixed very quickly if urgent action was taken by the Treasury. I am glad the Health Secretary is meeting representatives from the BMA, but will the Chief Secretary make a commitment that someone from the Treasury will meet the BMA? After all, this was a problem created in the Treasury.

For the first time, I find myself in agreement with the contributions from the Front Benchers from the Opposition and the Scottish National party. This problem has been coming down the track for at least three years and nothing has been done to stop it. The last thing the NHS needs is senior doctors refusing to work overtime at the weekends and our waiting lists getting worse, not better. The Chief Secretary has bravely come out to bat for the Treasury today, but we must avoid this silo mentality between the Treasury and the Department of Health and Social Care. This is a problem for the whole of the Government, and she and the Health Secretary need to get it sorted out urgently.

It is the responsibility of the Treasury to ensure that all public services are operating as efficiently as they can be, and that remit extends beyond NHS England; it extends across all parts of the NHS in the United Kingdom. Indeed, a friend who is a trainee surgeon in Glasgow was just telling me that the entire ear, nose and throat elective list was cancelled this weekend in Glasgow because of a shortage of anaesthetists. That arose because cover could not be found, owing to this perverse incentive we are discussing. Will the Chief Secretary therefore ensure that she writes not only to NHS England but to her counterpart in Scotland to ensure that this issue is effectively understood and the evidence is collated from all parts of the NHS in the UK?

The workforce is the No. 1 priority in the NHS, along with delivering the NHS plan, but we seem to be dealing here with a case of the right hand not knowing what the left hand is doing. When the right hand of the NHS is rightly commissioning Baroness Dido Harding to do a workforce plan, the left hand of Treasury policy is undermining that. Will the Chief Secretary make sure that Baroness Dido Harding’s work is fully integrated into the work she is doing on this.

Around six weeks ago, I raised this issue with the Prime Minister, who was sitting next to the Chancellor at the time, and I was told that they would come back to me. Since then, nothing has happened, and lots of my constituents—consultants and members of the public—are concerned about the deterioration in the situation at the hospitals. Surely the Chief Secretary or the Chancellor could sit down together with the Secretary of State for Health and Social Care and thrash this out.

I place on record the fact that I am married to a GP, although she is unlikely to be affected by the changes.

I recently attended a briefing for Fife’s elected representatives at which Fife Health and Social Care Partnership confirmed that an inability to recruit GPs means that the out-of-hours GP service in Glenrothes will remain closed almost permanently. We were given an update on the worrying number of GP practices—more than one in five—that are having difficulty recruiting and retaining GPs. The director of the partnership told us in terms that the pensions issue is a real one for medical staff, not just for GPs. In that context, it is not acceptable for the Treasury or, indeed, the Home Office, under reserved powers, to lob a hand grenade into our health service and expect the four devolved health services to fix the problem. Will the Chief Secretary tell us what assessment was made of the impact of the changes on the health service? Will she undertake to publish that assessment in full?

Will the Chief Secretary accept that such changes to the pensions process make it seem not worth while for consultants to do overtime, as they are taxed at a high rate multiple times? Furthermore, this will have a detrimental effect on waiting lists and, more importantly, on people’s lives. Will she be prepared to rethink the changes to ensure that those whom we need to work overtime and go the extra mile are not horrifically penalised for doing so?

1. What discussions he has had with the Secretary of State for Work and Pensions on the adequacy of social security spending in tackling poverty throughout the UK. [911674]

Some £30 billion of support to working-age people has been cut from the social security budget, and there is more still to come. Eight out of nine disabled people will not benefit from the measures introduced in last autumn’s Budget and over 4 million are living in poverty. In the Chancellor’s last few weeks in post, what will he do to right this wrong?

Can the Chief Secretary confirm that the number of children living in workless households is now the lowest ever record achieved in our country?

The Chancellor has been brave recently, speaking out on how no deal will impact our economy. Poverty will only get worse if we face no deal, so will the Chief Secretary be as brave as the Chancellor and tell this House the truth about poverty and no deal?

The Chancellor has been at the forefront of arguing that a decade of austerity was necessary. This has led to 24% of Scottish children and 30% of English children being in poverty. If the Chancellor believes that this pain was not ideological and unnecessary, will he vote against a Tory tax cuts for the rich Budget, as proposed by the Prime Minister’s most likely successor?

The Minister might not want to tackle inequality, but the Scottish Government do. The polls show that a majority of Scottish people support the tax changes that mean the Scottish Government can fund a £10 a week payment to families with the most vulnerable children, mitigating the ideological austerity obsession of this Conservative Government. If the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) becomes Prime Minister, 53% of Scots will support independence. And who can blame them, given the Scottish Government’s plans to support and help young people and this Government’s ideological austerity obsession?

As my hon. Friend the Member for Wirral South (Alison McGovern) said, the poorest, most vulnerable people in society, even those who are in work but struggling to make ends meet, will be hit particularly hard by a catastrophic no-deal Brexit. The Minister cannot get away with simply deflecting this into an attack, which I would share, on the economic policies of the Labour party. This is the clearest, most present danger facing our country, and surely she will not happily move towards a no-deal Brexit.

Yesterday, the Chancellor slapped down both Tory leadership candidates for making irresponsible spending promises. Has the Minister noticed, as we have, that not one of those promises was aimed at lifting the 4 million children out of poverty? She is responsible for the management of Government finances—heaven help us! What does she think this says about the Tory party and the next Prime Minister?

2. What discussions he has had with the Secretary of State for Scotland on the economic effect on Scotland of the UK leaving the EU. [911675]

8. What recent representations he has received from the Secretary of State for Education on the level of Government funding for early years education. [911681]

I hope the Chief Secretary has learned from those conversations and will go out to talk to early years providers. The shortfall in funding is having a huge impact. I visited a nursery in my constituency recently and it is clear that it is the staff who are bearing the brunt of it. They are on only just above minimum wage. I cannot help thinking that if the people working there were not women then perhaps their work would be valued more. Will she ensure that she makes representations, when the spending review comes, on lifting the freeze?

Will the Minister look particularly at funding for two-year-olds? Providers of early years education in my constituency tell me they lose money on providing that service for two-year-olds because there are significant additional costs in looking after two-year-olds but only a small uplift in the rate paid.

Children with higher educational needs are losing out even more. My local authority overspent by £760,000 last year and will overspend by £1.3 million this year and £1.9 million next year. Those children need this vital support in order to grow. Will the Minister look at the funding of the higher needs budget to ensure that local authorities can support those families?

9. What steps he is taking to maintain access to cash. [911683]

T3. The west midlands has seen knife crime rise by 106% in the past five years, the average time for the Crown Prosecution Service to reach a decision has increased by 64% since 2013, and more than 2,000 police officers have been lost since austerity began in 2010. Will the Chief Secretary to the Treasury make money available to reverse 10 years of Government cuts to police services to ensure that my constituents can feel safe? [911701]

T8. I congratulate my right hon. Friend and this Government on the net zero emissions climate change commitment. What are his plans to achieve that goal? [911706]

T10. Last month, the Wandsworth food bank published its yearly report. It showed that 5,770 emergency food parcels were handed out in a year—a 76% increase over five years; that nearly half of referrals were due to problems with social security, specifically the five-week wait for universal credit; and that nearly two thirds of those supported by a food bank adviser were disabled or had a long-term health condition. The consequence of Tory austerity is that record numbers of people are relying on charity to eat. Since this is probably the Chancellor’s final oral questions in post, may I ask whether he is proud of that legacy? [911708]

It has been a while since I asked the Chancellor about the blockchain and distributed ledger technology, so I was hoping that he could present an update on how the Treasury is embracing this new technology.

As my right hon. Friend the shadow Chancellor has just pointed out, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) has made £30 billion-worth of spending pledges and the right hon. Member for South West Surrey (Mr Hunt) has made £13 billion-worth of pledges. The Chancellor has said it will not happen on his watch, but that seems to suggest that a magic money tree has been found in the barren soil of the no deal for which we seem to be heading.

I want to ask the Chancellor about the pledges announced by the current Prime Minister in the past few weeks, which unfortunately have not included any compensation for the infected blood community. How have the Chancellor and the Treasury prioritised and costed those announcements?

What steps is my right hon. Friend taking to ensure that dementia care is adequately funded in the next spending review?

I welcome the Chancellor’s remarks about a no-deal Brexit and the disaster it would be for our country, costing jobs and livelihoods. Does he agree that both Conservative leadership candidates, who support a no-deal Brexit, should stop selling out the country to serve their own political ambitions? Will he commit to joining us in voting against a no deal when and if he returns to the Back Benches, and to voting with us on a no-confidence motion, if it comes to that, to stop a no deal?

The “All Kids Count” report, on the impact of the two-child limit after two years, was published last week by the Church of England, the Child Poverty Action Group, Women’s Aid, Turn2us and the Refugee Council. The report illustrates the devastating impact of the two-child policy, particularly on working families who are unable to compensate for the £2,780 a year cut by working longer hours. Before the Chancellor leaves office, will he scrap the two-child policy and its devastating impact on families?

The decision by the European Union to suspend the equivalence agreement with Switzerland seems to be very damaging. My right hon. Friend the Chancellor has done a fantastic job over the past few years. Will he confirm whether the United Kingdom was consulted on whether the decision should go ahead?

3. What discussions he has had with Cabinet colleagues on the fiscal effect of the no recourse to public funds condition on local authority budgets. [911003]

Will the Minister at least acknowledge that there is a problem? London boroughs are spending about £50 million a year—which they have to spend, but usually under the Children Act 1989—on families in extremis with no recourse to public funds. Will she acknowledge that that is the case and look at how local authorities are funded?

One specific issue in relation to the London Borough of Hammersmith and Fulham is the reopening of Hammersmith bridge. It is about time that the council got on with repairing and reopening the bridge. The council has a very good financial settlement. Will the Chief Secretary join me in knocking heads together between the council and Sadiq Khan’s Transport for London to get the bridge open?

Will the Minister commit to ensuring that survivors of domestic abuse with insecure immigration status have safe and confidential reporting systems, without fear of being returned to their country of origin?

The question is actually about the fiscal effects of the no recourse to public funds condition. I think I know what the hon. Lady is driving at, but I hope that other people are as aware of the connection as I am.

It was great to see the Minister on the Isle of Wight the week before last, although I am sad to say that there are not too many double entendres on her social media. She will be aware that I have written her a letter, asking her to ensure that the Isle of Wight becomes a pilot scheme in order for us to look at how we can better integrate Government services in the One Public Estate programme.

I am sure that the people of the Isle of Wight were most gratified that the right hon. Lady was among their number, even if only for a relatively short period.

9. What discussions he has had with Cabinet colleagues on the adequacy of Government funding to mitigate climate change. [911010]

The Liberal Democrats were the first major political party to call for a zero-carbon Britain. We believe that target must be met by 2045. What assessment have the Government made of the climate change mitigation costs that would be incurred by 2045, of the support that would be needed for businesses to help them achieve a zero-carbon Britain by 2045, and of the health and environmental benefits?

19. Climate change is increasing the risk of flooding, and despite devastating floods in my constituency in 2015, the Government have not yet committed funding for the one-in-200-year scheme that the Chief Secretary knows is needed to protect businesses in Kirkstall in my constituency. The gap now is just £23 million, so will the Government make it a priority in the comprehensive spending review, even if that spending review is just for one year? [911020]

Anneliese Dodds.

Thank you, Mr Speaker; take two. The Environment Secretary said to Extinction Rebellion that he, at least, had got the message, but of course days later his Government were panned by the Solar Trade Association for new tax changes that will affect solar and storage schemes. That contrasts with Labour’s announcement last week of plans for 1.75 million households to benefit from the solar energy revolution. So will this Government abandon the damaging changes to VAT, match Labour’s solar investment plans and actually start taking renewables seriously?

10. What assessment the Government have made of the environmental effect of freezing fuel duty since 2010. [911011]

The report by the all-party group on adult survivors of childhood sexual abuse demonstrated the economic impact of not supporting victims: 72% said it had had a negative impact on their career; 65% on their education; and 46% on their financial situation. The Chief Secretary to the Treasury said about survivors that

“it should be government’s responsibility to prioritise support for these people”.

Will the Chancellor prioritise support for these services in the spending review?

T2. The Government have an excellent track record in tackling climate change, notwithstanding what Opposition Members said earlier, and I applaud their commitment to doing more. Will the Chancellor consider introducing incentives in the comprehensive spending review to encourage occupiers and owners of industrial and agricultural buildings to improve their energy efficiency? [911027]

Ten days ago, I met heads and chairs of governors from across my constituency at Corfe Hill School. Will the Chief Secretary to the Treasury meet me to discuss their specific concerns about schools funding, and the need for additional funding for our schools in Poole and in Dorset as a whole?

T3. We are the last generation that can act to prevent irreversible harm from being done to our planet, so we need to act with urgency. Will the Chancellor bring forward the tax on the use of virgin plastic to boost recycling and incentivise plastic-free options? We do not have three years to wait. [911028]

What we want is a brief sentence on the Government’s policy. We are not having dilations on the policies of other parties; that is not the purpose of Question Time.

T6. The Government’s Social Mobility Commission recently stated that social mobility in the UK has stagnated over the last four years. One of its key recommendations is that the Government should significantly increase funding for further education in the upcoming spending review. Given that Bradford College plans to cut 131 of its staff, will the Chancellor listen to his Government’s own commission, boost FE funding and give the most disadvantaged students the opportunities they deserve? [911031]

What estimate has my right hon. Friend made of the effect on national debt of nationalising the National Grid and the effect it would have on the taxes paid by ordinary working people and the public services they receive in my constituency?

I am pleased to hear that education is going to get a special focus in the forthcoming spending review. Please can Somerset have special consideration, since pupils there get way below the national average in both secondary and primary school funding? With a sound economy, I am sure that we can sort this out.

Revenue funding continues to flow to oil refineries in the middle east at the expense of tidal technology, an area in which we are a world leader. When will this Government accept that investing in tidal energy would bring huge benefits to the whole economy?

I met headteachers and school governors across Cornwall recently, and they are very concerned about the pressure that their school budgets are under, so can I put in my bid for more money for education in the comprehensive spending review, and can we ensure that that money is fairly distributed so that schools in Cornwall get their fair share?